Clinical Endoscopy

The Comparison of Sizes Measured by Esophagogastroduodenoscopy and Endoscopic Ultrasonography in Small Submucosal Tumors: Gi Se Lee, M.D., Hyun Ju Yoon, M.D., Tae Hee Lee, M.D., Euyi Hyeng Im, M.D., Kyu Chan Huh, M.D., Young Woo Kang, M.D. and Young Woo Choi, M.D.; Korean J Gastrointest Endosc 2005;30(4):183-187. Published online April 30, 2005

Abstract PDF: Background
/Aims: Endoscopic ultrsonography (EUS) can provide detailed information about submucosal tumors such as size, echo pattern, wall of origin and relation to adjacent organs. However, EUS is not a cost effectiveness and time-consuming procedure and many patients experience discomfort during the procedure. We tried to verify the usefulness of Esophagogastroduodenoscopy (EGD) in the measurement of submucosal tumor size in comparison with EUS. Methods: We compare the size of small submucosal tumors from 68 patients measured by EGD and EUS at Konyang University Hospital from year 2000 to 2003. Results: Most of submucosal tumors were located in muscularis propria layer. The size of submucosal tumor measured by gastroscopy correlated well with the size by EUS (r=0.91). Submucosal tumor measured by EGD was slightly larger than EUS measurement (p=0.008). Conclusions: The size of submucosal tumors measured by EGD was slightly larger than that by EUS due to covering mucosa, but both sizes were linearly correlated. So we think that gastroscopy plays as one strategy for the surveillance or follow-up procedure of small sized submucosal tumors which do not exhibit the suspicion of malignant potential. (Korean J Gastrointest Endosc 2005; 30:183⁣187)

1,753 View
5 Download

Management of Colonic Perforation during Colonoscopic Procedure: Hwan Namgung, M.D., Moon Kyung Cho, M.D.*, Kang Hong Lee, M.D.*, Seung Jae Myung, M.D.^†, Suk Kyun Yang, M.D.^†, Chang Sik Yu, M.D.*, Hee Cheol Kim, M.D.* and Jin Cheon Kim, M.D.*; Korean J Gastrointest Endosc 2005;30(4):188-193. Published online April 30, 2005

Abstract PDF: Background
/Aims: Colonic perforation appears to be the most dangerous complication during colonoscopy. This study was designed to determine the optimal management for this infrequent accident. Methods: We reviewed the medical records of 17,510 colonoscopies which were performed during recent one-year period and found eight colonic perforations (0.05%). Results: Six perforations (0.04%) related to 16,695 diagnostic procedures, whereas two (0.25%) occurred from therapeutic procedures (p=0.05). Operative measures were applied in six (75.0%) patients showing signs of peritonitis. Five patients received primary closure without diversion, and resection with primary anastomosis was performed in one patient who had underlying tuberculous colitis. In addition, one patient was treated conservatively with bowel rest and intravenous antibiotics. Endoscopic clipping was applied in one patient with rectal perforation. Seven patients recovered uneventfully, and one 69-year-old male patient died of cardiogenic shock after the operation. Conclusions: Although colonic perforation occurs infrequently during colonoscopy, it may sometimes results in a fatal outcome. Primary closure without diversion appears to be appropriate in most cases without comorbid colonic disease. (Korean J Gastrointest Endosc 2005;30:188⁣193)

2,593 View
25 Download

Comparision of Single Versus Split-dose of Polyethylene Glycol-electrolyte Solution for Colonoscopy Preparation: Sang Hoon Kim, M.D., Dong Il Park, M.D., Seung Ha Park, M.D., Hong Joo Kim, M.D., Yong Kyun Cho, M.D., In Kyung Sung, M.D., Chong Il Sohn, M.D., Woo Kyu Jeon, M.D. and Byung Ik Kim, M.D.; Korean J Gastrointest Endosc 2005;30(4):194-198. Published online April 30, 2005

Abstract PDF: Background
/Aims: Although polyethethylene glycol (PEG) solution is widely used for bowel preparation, it is difficult to drink a large amount of fluid in a short period of time. We compared the quality of bowel preparation and compliance between the single-dose group and split-dose group. Methods: Two hundred seventeen patients undergoing outpatient colonoscopy were randomly assigned to receive either 4 litre (L) of PEG solution (n=104, single- dose group) on the day of colonoscopy or 2 L of PEG solution on the day before colonoscopy and then 2 L of same solution on the day of colonoscopy (n=113, split- dose group). The quality of bowel preparation was assessed using Ottawa scale. Cecal intubation time, compliance and side effects were assessed. Results: Split-dose group showed the better quality of bowel preparation than single-dose group (4.75⁑2.45 vs 5.52⁑2.24, p＜0.05) because of lower residual volume scale. Patients who experienced very difficulty during ingestion (0.95% vs 5.8%) and left out more than 25% of PEG solution (3.5% vs 8.7%) were greater in single-dose group. There was no difference of side effects between two groups. Conclusions: Split-dose PEG preparation could be the useful method in than single-dose in colonoscopy preparation. (Korean J Gastrointest Endosc 2005;30:194⁣198)

2,752 View
39 Download

A Case of Gastric Perforation due to Endoscopic Mucosal Resection Managed by Detachable Snare and Hemoclips: Dong Won Lee, M.D., Sung Gyu An, M.D., Sun Mi Lee, M.D., Seong Hun Lee, M.D., Tae Oh Kim, M.D., Jeong Heo, M.D., Gwang Ha Kim, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D., Mong Cho, M.D. and Do Youn Park, M.D.*; Korean J Gastrointest Endosc 2005;30(4):199-203. Published online April 30, 2005

Abstract PDF: The detachable snare, by Pontecorvo and Pesce in 1986, was designed for the prevention of bleeding after endoscopic mucosal resection (EMR) of a polyp. It has been used widely for the ligation of large gastric or duodenal variceal bleeding, and even for the resection of a colon polyp. But detachable snare has been rarely used in the treatment of gastric perforation after the EMR. Herein, we report a successful case of detachable snare application in the treatment of gastric perforation caused by EMR in a patient with gastric adenoma measuring 1.6⁓1.6 cm in size, along with the review of relevant literatures. (Korean J Gastrointest Endosc 2005;30:199⁣203)

2,361 View
8 Download

A Case of Duodenal Relapse of Epstein-Barr Virus-positive, CD56-negative Extranodal NK/T-cell Lymphoma, Nasal Type: Kyu-Jong Kim, M.D., Gin Hyug Lee, M.D., Seong Soo Hong, M.D., Jeong-Sik Byeon, M.D., Suk-Kyun Yang, M.D., Jin-Ho Kim, M.D., Young Il Min, M.D. and Joo Ryung Huh, M.D.*; Korean J Gastrointest Endosc 2005;30(4):204-209. Published online April 30, 2005

Abstract PDF: Mature T-cell and natural killer-cell neoplasms account for 10 to 15% of all non-Hodgkin's lymphomas. Of the various subtypes of mature T-cell and NK-cell lymphomas, extranodal NK/T-cell lymphoma, nasal type (nasal type NK/T-L) is relatively more common among Asians including Koreans. Nasal type NK/T-L is an aggressive, Epstein-Barr virus-associated lymphoma with characteristic expression of NK-cell antigen CD56. In this report, we present an unusual case of EBV(⁢), CD56(⁣) NK/T-L of oropharynx which recurred in duodenum after the period of complete remission lasting for 10 years. A 58-year-old woman presented with 3 months history of abdominal pain. Gastroduodenoscopy showed the diffuse wall thickening with multiple ulcerations in bulb and proximal second portion of the duodenum. Pathological examination revealed the infiltration of atypical lymphocytes, which was positive for CD3, CD4, CD5, TIA-1, and EBV and was negative for CD15, CD20, and CD56, consistent with NK/T-L of mature T-cell origin. The past medical history included the presence of oropharyngeal mass 10 years earlier, which was diagnosed as polymorphic reticulosis. The mass resolved completely after the radiation therapy, and she remained free of the disease for 10 years. Upon review, the oropharyngeal biopsy showed an identical morphology and immunophenotype with duodenal lesion. In conclusion, we experienced an unusal case of NK/T-cell lymphoma, nasal type recured in the duodenum. (Korean J Gastrointest Endosc 2005;30:204⁣209)

1,964 View
8 Download

A Case of Pneumatosis Cystoides Intestinalis: Kwang An Kwon, M.D., Yu Kyung Kim, M.D., Sun Suk Kim, M.D., Yeon Suk Kim, M.D., So Young Kwon, M.D., Yang Suh Ku, M.D., Duck Joo Choi, M.D., Ju Hyun Kim, M.D., Ha Na Kim, M.D.* and Dong Hae Jung, M.D.^†; Korean J Gastrointest Endosc 2005;30(4):210-216. Published online April 30, 2005

Abstract PDF: 장관 포상 기종은 발생기전과 치료가 아직 확실하지 않은 드문 질환으로 위장관의 장막 또는 점막하층에 발생하는 다발성 함기성 낭포를 가진다. 호발 연령은 25∼60세이고, 남자에서 호발하며 소장을 주로 침범 하고 85%에서 다른 소화기, 호흡기, 교원성 질환 등을 동반한다. 특징적인 증상이 없어서 과거에는 수술이나 부검 시 우연히 발견되었으나 최근에는 전형적인 방사선학적 소견과 대장내시경 검사 및 전산화단층촬영으로 진단이 가능하게 되었다. 장관 포상 기종은 자연 소실되기도 하며, 산소 흡입, 항생제 투여, 식이요법, 내시경적 경화술 및 수술 등으로 치료하고 있다. 괴사성 장염을 동반한 영아에서는 사망률이 높으나 성인에서는 보통 양호한 임상 경과와 예후를 가지며, 약 3%에서는 장폐쇄, 장염전, 장중첩증, 복강기종, 장출혈, 장천공 등의 합병증이 발생할 수 있다. 저자 등은 울혈성 심부전을 동반한 당뇨병 환자가 복통을 주소로 내원하여 시행한 단순 복부촬영과 대장내시경검사에서 장관 포상 기종을 발견하고, 복부 전산화단층촬영과 조직병리검사에서 장관 포상 기종으로 진단된 증례를 경험하였기에 문헌고찰과 함께 보고하고자 한다.

1,695 View
17 Download

Ileal Perforation due to Cytomegalovirus Enteritis in a Patient with Acquired Immune Deficiency Syndrome: Yeon Soo Kim, M.D., Won Seok Heo, M.D., Kyung Hoon Chae, M.D., Youn Se Gang, M.D., Jae Hoon Jung, M.D., Ki O Park, M.D., Jae Kyu Seong, M.D., Yeon Sook Kim, M.D., Hyun Yong Jeong, M.D. and Geu Sang Song, M.D.*; Korean J Gastrointest Endosc 2005;30(4):217-221. Published online April 30, 2005

Abstract PDF: Cytomegalovirus (CMV) infection is one of important opportunistic infections and cause significant morbidity and mortality in immunocompromised patients. The colon, stomach, and esophagus are the organs frequently involved with CMV infection. CMV enteritis makes up less than 10% of the CMV gastroenteritis cases, usually presents with diarrhea, bleeding and perforation. Several reports have described patients with acquired immune deficiency syndrome (AIDS) in whom CMV enterocolitis were complicated by ileal perforation, but have been rarely reported in Korea. We report a case of multiple ileal perforation associated with CMV enteritis in 67 years old man who was diagnosed as AIDS later. He complained of hematochezia and abdominal pain. During emergency operation, multiple perforated lesions were seen at the distal ileum above ileocecal valve. Colonoscopic examination revealed multiple shallow aphthoid ulcers at descending colon. CMV enteritis and colitis were diagnosed by microscopic findings of both surgical and endoscopic specimens. He was recovered by antiviral therapy with ganciclovir. (Korean J Gastrointest Endosc 2005;30:217⁣221)

1,968 View
7 Download

Solitary Peutz-Jeghers Polyp of the Colon: Seok Jeong, M.D., In Suh Park, M.D.*, Yong Sun Jeon, M.D.^†, Jin-Woo Lee, M.D., Jung Il Lee, M.D., Kye Sook Kwon, M.D., Don Haeng Lee, M.D., Pum-Soo Kim, M.D., Hyung Gil Kim, M.D., Yong Woon Shin, M.D. and Young Soo Kim, M.D.; Korean J Gastrointest Endosc 2005;30(4):222-225. Published online April 30, 2005

Abstract PDF: Peutz-Jeghers syndrome is an autosomal-dominant inherited disorder characterized by polyposis of the alimentary tract, the abnormal mucocutaneous pigmentation, and family history of Peutz-Jeghers syndrome. A single Peutz- Jeghers polyp arising in a patient without pigmentation and family history of Peutz-Jeghers syndrome is termed a solitary or isolated hamartomatous polyp of Peutz-Jeghers type. These solitary polyps are found most frequently in the small intestine but also occur in the large bowel and stomach as well. In a healthy 48-year-old man, a single large polyp was found incidentally in the ascending colon during colonoscopy and treated by snare polypectomy. Microscopic exam of the resected specimen revealed the features of hamartomatous polyp of Peutz- Jeghers type. There was no evidence of other polyps on esophagogastroduodenoscopy and small bowel series. We report a patient with solitary Peutz-Jeghers polyp of the colon, who had no stigmata associated with Peutz-Jeghers syndrome. (Korean J Gastrointest Endosc 2005;30:222⁣225)

2,002 View
15 Download

A Case of Adult Idiopathic Ileocecal Intussusception Reduced by Colonoscopy: Kyoung Min Kim, M.D., Jong Han Kim, M.D., Tae In Ha, M.D., Sang Ryul Chung, M.D., Seung Soo Moon, M.D., Eun A Lee, M.D., Soo Hyoung Lee, M.D., Yong Mok Bae, M.D., Jeong Ho Heo, M.D. and Yong Seon Pyeun, M.D.*; Korean J Gastrointest Endosc 2005;30(4):226-229. Published online April 30, 2005

Abstract PDF: Intussusception frequently occurs in children as the main causes of intestinal obstruction in childhood but relatively rare in adult. A 65-year-old male visited our hospital because of abrupt onset right lower quadrant pain with tenderness for three days. He had a previous history of appendectomy and alcoholic liver cirrhosis. On physical exam, bowel sound was decreased. Abdomen ultrasonography showed a kidney like mass and abdominal computed tomography revealed the typical target lesion in the ileocecal area. Colonoscopy was performed which failed to find any lesion leading to intussusception. After the colonoscopy, the abdminal pain had disappeared, and we would not find any intussusception sign by abdominal ultrasonography. Colonocopy was done two weeks later. No pathologic lesion was found, then. We report a case of adult idiopathic ileocecal intussusception reduced by colonoscopy. (Korean J Gastrointest Endosc 2005;30:226⁣229)

2,072 View
7 Download

A Case of Acute Pancreatitis Caused by Santorinicele with Incomplete Pancreas Divisum: Dong Won Lee, M.D., Dong Yup Ryu, M.D., Bo Hyun Kim, M.D., Jung Sup Kim, M.D., Young Eun Park, M.D., Seong Hun Lee, M.D., Tae Oh Kim, M.D., Suk Kim, M.D.*, Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and Mong Cho, M.D.; Korean J Gastrointest Endosc 2005;30(4):230-233. Published online April 30, 2005

Abstract PDF: A focal cystic dilatation of the terminal portion of the dorsal pancreatic duct at the minor papilla, termed "santorinicele", is seen in a small number of patients with pancreas divisum. Santorinicele is believed to result from a combination, either acquired or congenital, of relative obstruction and weakness of the distal ductal wall and has been suggested as a possible cause of relative stenosis of the accessory papilla, a risk factor for pancreatitis. We report a case of santorinicele associated with incomplete pancreas divisum, found in a 68-year-old woman presented with acute pancreatitis with a brief review of the literatures. (Korean J Gastrointest Endosc 2005;30:230⁣234)

1,847 View
14 Download

Previous issues